Longitudinal peanut and Ara h 2 specific-IgE, -IgG4, and -IgG4/-IgE ratios are associated with the natural resolution of peanut allergy in childhood

Kayla M Parker; Thanh D Dang; Rushani Wijesuriya; Victoria X Soriano; Adrian J Lowe; Shyamali C Dharmage; Paxton Loke; Mimi L K Tang; Katie J Allen; Jennifer J Koplin; Kirsten P Perrett; Rachel L Peters

doi:10.1111/all.16111

Longitudinal peanut and Ara h 2 specific-IgE, -IgG₄, and -IgG₄/-IgE ratios are associated with the natural resolution of peanut allergy in childhood

Allergy. 2024 May 8. doi: 10.1111/all.16111. Online ahead of print.

Authors

Kayla M Parker^{1

2}, Thanh D Dang^{1

2}, Rushani Wijesuriya^{1

2}, Victoria X Soriano^{1

2}, Adrian J Lowe^{1

3}, Shyamali C Dharmage^{1

3}, Paxton Loke^{1

2

4}, Mimi L K Tang^{1

2

5}, Katie J Allen^{1

2}, Jennifer J Koplin^{1

6}, Kirsten P Perrett^{1

2

5}, Rachel L Peters^{1

2}

Affiliations

¹ Murdoch Children's Research Institute, Parkville, Victoria, Australia.
² Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
³ Melbourne School of Population and Global Health, University of Melbourne, Parkville, Victoria, Australia.
⁴ Monash Children's Hospital, Monash Health, Clayton, Victoria, Australia.
⁵ Department of Allergy and Immunology, Royal Children's Hospital, Parkville, Victoria, Australia.
⁶ Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia.

PMID: 38720169
DOI: 10.1111/all.16111

Abstract

Background: There are no studies of longitudinal immunoglobulin measurements in a population-based cohort alongside challenge-confirmed peanut allergy outcomes. Little is known about biomarkers for identifying naturally resolving peanut allergy during childhood.

Objectives: To measure longitudinal trends in whole peanut and component Ara h 2 sIgE and sIgG₄ in the first 10 years of life, in a population cohort of children with challenge-confirmed peanut allergy, and to determine whether peanut-specific immunoglobulin levels or trends are associated with peanut allergy persistence or resolution by 10 years of age.

Methods: One-year-old infants with challenge-confirmed peanut allergy (n = 156) from the HealthNuts study (n = 5276) were prospectively followed at ages 4, 6, and 10 years with questionnaires, skin prick tests, oral food challenges, and plasma total-IgE, sIgE and sIgG₄ to peanut and Ara h 2.

Results: Peanut allergy resolved in 33.9% (95% CI = 25.3%, 43.3%) of children by 10 years old with most resolving (97.4%, 95% CI = 86.5%, 99.9%) by 6 years old. Decreasing Ara h 2 sIgE (p = .01) and increasing peanut sIgG₄ (p < .001), Ara h 2 sIgG₄ (p = .01), peanut sIgG₄/sIgE (p < .001) and Ara h 2 sIgG₄/sIgE (p < .001) from 1 to 10 years of age were associated with peanut allergy resolution. Peanut sIgE measured at 1 year old had the greatest prognostic value (AUC = 0.75 [95% CI = 0.66, 0.82]); however, no single threshold produced both high sensitivity and specificity.

Conclusion: One third of infant peanut allergy resolved by 10 years of age. Decreasing sIgE and sIgG₄ to peanut and Ara h 2 over time were associated with natural resolution of peanut allergy. However, biomarker levels at diagnosis were not strongly associated with the natural history of peanut allergy.

Keywords: Ara h 2; IgE; IgG4; peanut; resolution.

Abstract

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